12050095 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10183PARKWOODDR CONTRACTOR:STEVE PLEVANCIC PERMIT NO: 12050095
CONSTRUCTION
OWNER'S NAME: AVERY GLENBROOK LP 528 S h1ATHILDA AVE STE 2 DATE ISSUED:05/092012
OWNER'S PHONE: 6509618330 SUNNYVALE,CA 94086 PHONE NO:(408)8069145
❑
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r
License Class";j /5 Lic.p - - / - - -
c -� PIn `j C� MECH r RESIDENTIAL r COMMERCIAL
Contractorr
_� CUOLinCatDnte-
I hereby affirm that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION: BLDG 52-R-2 COMPLEX 24 WINDOW REPLACEMENTS:
(commencing with Section 7000)of Division 3 of the Business&Professions NON-STRUCTURAL
Code and that my license is in full force and effect.
1 hereby affirm under penalty of perjury one of the following two declarations:
I have and will maintain a certificate of consent to selGinsure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance,m provided for by Sq.FI Floor Area: Valuation:$6000
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued.
APPLICANT CERTIFICATIONAPN Number:32627037.10183 Occupancy Type:
I certify that I have read this application and state that the above information is
correct-I agree to comply with all city and county ordinances and state laws relating
to building construction,and hereby authorize representatives of this city to enter PERMIT EXPIRES IF WORK IS NOT STARTED
upon the above mentioned property for inspection purposes. (We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgment,, WITHIN 180 DAYS OF PERMIT ISSUANCE OR
costs,and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION.
granting of this permit. Additionally,the applicant understands and will comply
with all non-p int source regulations per the Cupertino Municipal Code,Secti
9.18. Issued bj. Date: S-' / Z
Signature Date t7
❑ OWNER-BUILDER DECLARATION RF.-ROOFS:
All roofs shall be inspected prior 10 any roofing material being installed.If a roof is
1 hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,1 agree to remove all new materials for
the following two reasons: inspection.
1,as owner of the property,or my employees with wages as their sole compensation,
will do the work,and the structure is not intended or offered for sale(Sec.7044, Signature of Applicant: Date:
Business&Professions Code)
I,as owner of the property,ant exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I hereby affirm under penalty of perjury one of the following three
declarations: HAZARDOUS MATERIALS DISCLOSURE
I have and will maintain a Certificate of Consent 10 self-insure for Worker's 1 have read the hazardous materials requirements under Chapter 6.95 of the
Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safely Code,Sections 25505,25533,and 25534. I will maintain
performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(x)should 1 store or handle hazardous material.
Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air
permit is issued- contaminants as defined by the Bay Area Air Quality Management District I will
maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
I certify that in the performance of the work for which this permit is issued,I shall Health&Safety Code,Sections 25505,25533,and 25534!
not employ any person in any manner so as to became subject to the Worker's {'
Compensation laws of California. If,after making this certificate ofexempuon,l Ow ut zed agent:
become subject to the Worker's Compensation provisions of the Labor Code,I must — Date:
fonhvvith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of work's
I certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.)
correct. I agree to comply with all city and county ordinances and state laws relating Lender's Name
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the
granting of this permit.Additionally,the applicant understands and will comply ARCIIITECT'S DECLARATION
with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records.
9.18.
Licensed Professional
Signature Dale
CITY OF CUPERTINO
3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN 32627037.10183
DATE ISSUED. . . . . . . : 05/09/2012
RECEIPT #. . . . . . . . . : BS000016770
REFERENCE ID # . . . : 12050095
SITE ADDRESS . . . . . : 10183 PARKWOOD DR
SUBDIVISION . . . . . . .
CITY _ . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : AVERY GLENBROOK LP
ADDRESS . . . . . . . . . . : 130 E DANA ST
CITY/STATE/ZIP . . . : MOUNTAIN VIEW, CA 94041-1508
RECEIVED FROM . . . . : STEVE P PLEVANCIC
CONTRACTOR . . . . . . . : STEVE PLEVANCIC LIC # 32967
COMPANY . . . . . . . . . . : STEVE PLEVANCIC CONSTRUCTION
ADDRESS . . . . . . . . . . : 528 S MATHILDA AVE STE 2
CITY/STATE/ZIP . . . : SUNNYVALE, CA .94086
TELEPHONE . . . . . . . . (408) 806-9145
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
--------- ------------- ---------- ---------- ---------- ----—---- --------—
1BCBSC VALUATION 6, 000.00 1 . 00 0. 00 1 .00 0 .00
1BSEISMICR VALUATION 6, 000.00 0.60 0. 00 0.60 0.00
1WINREP EACH 8 24 .00 652. 00 0. 00 652.,00 0. 00
---------- ---------- ---------- ----------
TOTAL PERMIT 653 .60 0. 00 653 .60 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 653 .60 VISA
---------------
TOTAL RECEIPT 653 .60
CITY OF CUPERTINO
FEE ESTIMATOR— BUILDING DIVISION
ADDRESS: 10183 parkwood dr. DATE: 05/09/2012 REVIEWED BY: bob s.
APN: BP#: 'VALUATION: $6,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIMARY Multi-Family Dwelling Buildina is PENTAMATION 1GENRES
USE: 3 Stories O Yes O No PERMITTVPE:
WORK "lex lex 24 window replacements non structural.
SCOPE
.Vfeeh. Plan Cheek Plumb. Plan Cheek E/ec. Plan Check
dlreh. 11rrmil Fre: Plumb. Pe,ml(Fec: filer. Pemuil Fee:
Orhri .Ilvi h. Imp. Other Plumb Insp. Lj 011rrr filer. lap.
.I kxh.br,p. Plc: Phuuh. hup.Fre: 6lrc Ing). Fre:
NOTE: This estimate does not includejees due to other Departments(Le.Planning,Public Works, Fire,Sanitary Sewer District,School
District,etc.). These fees are based on the prefintina information available and are only an estimate Contact the Deal for addn7 info.
FEE ITEMS (Fee Nesohuion 11-053 EIL 7/1/11) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 r-247-1 # Window/Sliding Glass Door
Suppl. PC Fee: Q Reg. O OT0:0 hrs $0.00 $652.00 IWINREP Replacement
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. FeelD Reg. O OT '6.0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Carslrurrion Tax.
ilchninistralive Fee. O
Work Without Permit? O Yes- Q No $0.00 0
Advanced Plannink Fee: $0.00 Select a Non-Residential (D
Travel l.)ocumenlarion Foes: Building or Structure O
A
Stronk Motion Fee: IBSEISAECR $0.60 Select an Administrative Item
Bide, Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: 1 $1.60 $652.00 TOTAL FEE: $653.60
Revised: 04/01/2012
CONSTRUCTION PERMIT APPLICATION 12(
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COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING_ DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228• FAX(408)777-3333-buildinO(0)cuoertino ora
CUPERTINO
❑NEW CONSTRUCTION ❑ ADDITION ALTERATION/TT ❑ REVISION/DEFERRED ORIGINAL PER-I&T R
PROTECT ADDRESS 1Q rA W Q
10 �
'OWNER NAME 41/&-/Z Y 6Y e-1-2aco;t 1-/0 PHONE`S-O-96/
_k EMAIL�L��S �.
slT�r 3 t RESS arY. AVL'! t v 14A-J
CONTACT NAME ?�tONE
—c-f � E-vAn�GtC- `to,Y-$o6- 974 )� STC ti �J �g Ata- I �4�
STREET ADDRESS }I CITY.STATE, ZIP b� F
13OWNER 11OwNER-BurLDER 13 OWNER AGENT U-WNTRAcroR ❑CONTI ACTOR AGENT ❑ AR=(7r ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME LICENSE NUMB i !� T.ICENSETYPE jz BUs.LIC#
COMPANY NAME (Je4 f4o
e,f- I >7 t set, CU eO c ma, l,60'm
STREET ADDRESSS
9TA'fE,ZIPPUONE
a7 ' 5 �1 vu le -6706- S
ARCHRT_R/ENGnIIDINAME , ) .A_ LICENSE NUNMER BUs.LICA
COMPANY NAME 1 v Y c E-MAIL FAX
STREETADDRESS /J /7 CfrY,STATE,ZIP r� 1 PHONE
DESCRIPTION OF WORK {( n �� 7 �eD Y.C� / � I NI ✓I�GW 5 / -
EXSRNG USE PROPOSEDUSE CONSTR.TYPE YSTORIES
`r— USE TYPE OCC. SQFT. VALUATION(S)
NEW FLOOR DEMO
AREA
AREA AREA AREA NEI'.AR81
BATHROOM KITCHEN OTHER
REMODEL AREA REMOOMAAEA REMODEL AREA
PORCH AREA DE71A
TOTAL DECK/PORCH AREA GARAGE AREA DETACH
ATTACH
p DWELIA'G UNITS: SECOND UNIT YES SECOND STORY YES
BEPIG ADDED? LINO ADDMOM. ONO
PRE-APPLICATION
OYES 7 YES,PROVIDE COPYOF ra TERBLDCAN ❑YES RECEIVED EY: TOTALV VALUATION:
PLANNINOAPPL® ONO PLANNING APPROVAL LEITER RICHLEREOMRr ONO
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on rhe prpperty owner's behalf. I have read this
application and the information I ha a vidcd is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws[elating ding c tion. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant(Agent Date: i -L
SUPPLEMENTAL INFORMATION REQUIItED PLAN C ECKTYPE ROUTING SLIP
New SFD or Multifamily dwellings: Apply for demolition permit for eS OVER TIS-CODNT'ER -Q a n m0 PLAN REVMW
existing building(s). Demolition permit is required prior to issuance of building
permit for new building. ❑ EXPRESS ❑ PLANNmc PLAN REVMW
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PURuc WORKS
To=- if any Hazardous Materials are being used as part of this project
❑ LARGE ❑ EmKnrrr
_Copy of Planning Approval Letter or Meeting with Planting prior to ❑ MAIOR 11 s,vIrARY sEwve DLsrRter
submitral of Building Permit applicatioD. -
❑ E.WIRONMENTAL BFALTR
-B1d9App_d011.doc revised 06121/11